Main description:

Learn to complete and submit clean claim forms for major insurance carriers. Health Insurance Today, 3rd Edition, provides case studies for each of the chapters covering these major payers so you can learn how to abstract the information from the patient's chart to complete the CMS-1500. You will learn to complete and submit paper claims, but the emphasis is on electronic claims filing, keeping you up-to-date on HIPAA, electronic health records, and the latest industry standards. Select exercises on the companion Evolve Resource site let you gain experience entering information into a practice management program; producing an electronic CMS-1500; and submitting a claim electronically.

Contents:

Unit 1: Building a Foundation 1. The Origins of Health Insurance 2. Tools of the Trade: A Career as a Health (Medical) Insurance Professional 3. The Legal and Ethical Side of Medical Insurance 4. Types and Sources of Health Insurance Unit 2: Health Insurance Basics 5. Claim Submission Methods 6. Traditional Fee-for-Service/Private Plans 7. Unraveling the Mysteries of Managed Care 8. Understanding Medicaid 9. Conquering Medicare's Challenges 10. Military Carriers 11. Miscellaneous Carriers: Workers' Compensation and Disability Insurance Unit 3: Cracking the Codes 12. Diagnostic Coding 13. Procedural, Evaluation and Management, and HCPCS Coding Unit 4: The Claims Process 14. The Patient 15. Keys to Successful Claims Management Unit 5: Advanced Application 16. The Role of Computers in Health Insurance 17. Reimbursement Procedures: Getting Paid 18. Hospital Billing and the UB-04 Appendix A: Sample Blank CMS-1500 (02-12) Appendix B: CMS-1500 Claim Forms and Completion Instructions Appendix C: UB-04 Claim Form and Completion Instructions Glossary